Fifth Stage
E.N.T
Dr. Mushtaq – Lecture 4
1
Otitis Media with effusion
Non Suppurative Otitis Media
Definition
A clinically non-infective non-suppurative form of fluid collection behind an intact
TM.
Other Synonyms for Otitis media with effusion
•
Secretory om.
•
Exudative om.
•
Serous om.
•
Glue ear.
Patho-physiology
•
Acute ET obstruction ME vacuum vascular engorgement transudation of serous
fluid from subepithelial vessels <<Acute serous OM.
•
Glandular hypertrophy production of viscid mucus in chronic secretory om
Aetiology
- frequently in male children/ 4 years
1. Occlusion of the eust.tube which may result from :
a- adenoid hypertrophy
b- salpingitis
c- stricture or adhesion of tubal orifice after surgery/ adenoidectomy.
d- ulceration or neoplasm of the post nasal space involving the pharyngeal
orifice
e- paralysis of the palatal muscles
2. Unresolved acute om.
3. Viral infection of the middle ear cleft.
4. Allergy e,g: hay fever.
5. Cleft palate & its` repair if the pterygoid hamulus is fractured .
2
Clinical features:
1) Deafness :
Conductive
2) Tinnitus :
Bubbling noise in the ear
3) Impaired speech & language development
Diagnosis:
•
History of hearing loss obtained from parents in young children
•
Feeling of fullness in the ear following flu.
•
Behavioral& scholastic difficulties , insularity, shouting or increasing TV volume.
Otoscopical examination:
•
TM. Is dull & retracted .
•
Horizontal crescent hair line
•
Air bubbles on blowing
•
Grey to ... Black // blue drum
•
Mobility can be assessed by blowing or seigle`s or pneumatic otoscope
Investigations:
A. Tuning fork test: > 4 years // --ve
B. Audiometry : conductive hearing loss
C. Tympanometry :
•
decrease compliance( B)or
•
negative middle ear pressure(C)
D. Tympanocetesis : sterile X infected
serous X glue
3
Treatment:
1- Medical R,:
* 50% may resolved spontaneously within
3months
* elimination of the aetiological & predisposing
factors.
* many trials of R, with AB, steroid, decongestant,
antihistamines & prostaglandin inhibitors .
2- Surgical R,
•
Indication: Persistent disease> 3months with significant hearing loss
1) Myringotomy alone
2) Myringotomy +ventilation tube ( grommet)
3) Adenoidectomy+/- ts
4
Thank you,,,